After delays, city unveils first part of mental health roadmap

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First Lady Chirlane McCray, center, at the announcement. (nycmayorsoffice)
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Dan Goldberg

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The de Blasio administration announced Tuesday it will work with hospitals across New York City to increase the prevalence of prenatal and postpartum depression screenings.

The announcement made at Bellevue Hospital in Manhattan was billed as a part of first lady Chirlane McCray’s mental health roadmap, a document she promises will be "the most comprehensive municipal road map ever developed in the United States." 

The rest of the roadmap, which is being eagerly anticipated by mental health advocates, will be released in a few weeks, said McCray, who has made the issue her priority as a member of her husband's administration, and has frequently spoken of the de Blasio family's personal struggles with mental health.

“Asking for help during what is considered one of the most joyous periods in a parent’s life can be daunting,” she said. “No woman wants to be a bad mother.”

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The roadmap has come in for some preemptive criticism for its broad ambitions, but the announcement on Tuesday focused specifically on new mothers.

Approximately 10 percent of women suffer from postpartum depression, McCray said, and studies show most women do not seek treatment, so the numbers may be even higher. Black and Latino women are less likely to receive treatment compared to white women, she added.

What McCray would like to see is depression screening become as common as blood pressure checks. 

That won’t be easy.

For years, mental health experts and public health officials have called for screening pregnant women and new moms, but the stigma that surrounds mental health has remained a persistent concern, and has proven hard to eliminate.

In 2009, the city’s health department released a report looking at barriers to depression screenings at hospitals in Brooklyn.

That report outlined the same problems spoken about on Tuesday and offered several recommendations, but it appears they did not take hold.

The American Medical Association and the American Congress of Obstetricians and Gynecologists have previously recommended clinicians screen for maternal depression.

And last year, State Senator Liz Krueger and Assemblyman Richard Gottfried helped pass a law that, according to the Wall Street Journal, created statewide screening guidelines for new mothers, expanded pediatricians’ scope of practice so they can screen women, and mandated that new moms be educated on maternal depression before leaving the hospital or birthing center. That law is also intended to promote awareness of, and destigmatize, maternal depression. 

Like that state law, McCray’s proposal comes with no mandate for follow-up care, and no new funding to train providers to deal with additional screenings.

“This initiative is not primarily about new dollars,” said Deputy Mayor Richard Buery, who is helping to coordinate the implementation of the roadmap. “It is primarily about new practices.”

The announcement included a commitment from Brooklyn’s Maimonides Medical Center and the city’s public hospital system to screen all women they see within two years time.

Those two institutions account for about 25 percent of all births in the city.

The Greater New York Hospital Association, a trade group that represents hospitals, committed to creating a learning network so that its members can work to increase screenings.

That will include a steering committee to assess the current level of activity and what resources are needed, said GNYHA president Ken Raske.

Neither the de Blasio administration nor GNYHA know just how often screenings currently take place in New York City, but they aim to find out.

There is also no firm commitment yet to expand capacity so that all these newly diagnosed women have a place to turn to for treatment of their depression.

Buery said the roadmap will discuss that in greater detail, and outline how the city plans to close treatment gaps.

“Part of the new workflows we will be creating is making sure people get the care they need,” Buery said.

The roadmap was first announced in January when McCray said it would be ready in the summer. But its release been delayed at least twice, leaving the impression among some advocates that the de Blasio administration underestimated the complexities of the issue.